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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 5/2016

01-08-2016 | ORIGINAL ARTICLE

Cholangitis in the postoperative course after biliodigestive anastomosis

Authors: Sebastian Cammann, Kai Timrott, Ralf-Peter Vonberg, Florian W. R. Vondran, Harald Schrem, Sebastian Suerbaum, Jürgen Klempnauer, Hüseyin Bektas, Moritz Kleine

Published in: Langenbeck's Archives of Surgery | Issue 5/2016

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Abstract

Background

Hepatobiliary surgery with biliodigestive anastomosis (BDA) results in a loss of the sphincter of Oddi with consecutive ascension of bacteria into the bile system which may cause cholangitis in the postoperative course.

Methods

Patients who received reconstruction with a BDA after hepatobiliary surgery were analyzed retrospectively for their postoperative course of disease depending on intraoperatively obtained bile cultures and antibiotic prophylaxis.

Results

Two hundred forty-three patients were included in the analysis, 49.4 % of whom had received endoscopic stenting before the operation. Stenting was significantly associated with the presence of drug-resistant bacteria in the intraoperatively obtained bile sample (p < 0.001, OR = 4.09). Of all patients, 14.4 % developed postoperative cholangitis. This was significantly associated with the postoperative length of stay in the intensive care unit (p = 0.002, OR = 1.035). The highest incidence of postoperative cholangitis was found in patients with cholangiocellular carcinoma (n = 12, p = 0.046, OR = 2.178). Patients were more likely to harbor strains with resistance against the antibiotic that was given intraoperatively.

Conclusion

The risk for the presence of drug-resistant bacteria is increased by preoperative stenting of the common bile duct. Bile culture by intraoperative swabs can be altered by the perioperative antibiotic prophylaxis as it induces microbiological selection in the common bile duct.
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Metadata
Title
Cholangitis in the postoperative course after biliodigestive anastomosis
Authors
Sebastian Cammann
Kai Timrott
Ralf-Peter Vonberg
Florian W. R. Vondran
Harald Schrem
Sebastian Suerbaum
Jürgen Klempnauer
Hüseyin Bektas
Moritz Kleine
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 5/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-016-1450-z

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